Summary. A retrospective longitudinal review identified 341 women who had had a hysterectomy in association with CIN 3, in Tayside Region, during the ycars 1967–1977; 219 (64%) had completed l0 years of cytology follow‐up and of 140 women eligible for 15‐year smears 79 (56%) completed the 15‐year follow‐up. Eight (4%) of the 219 patients developed abnormal cytology, but in six, smears reverted to normal spontaneously. Two patients had persistently abnormal smears and vaginal intraepithelial neoplasia (VAIN) was diagnosed. Only one patient completing 15‐year follow‐up had an abnormal smear and VAIN later diagnosed. No patient over this 15‐year period developed invasive vaginal carcinoma. Sixty vaginal carcinomas were identified during the period 1957–1987 from the gynaecology cancer register; only one was associated with a previous diagnosis of CIN 3 at hysterectomy. With such data we would propose screening 6‐monthly during the first postoperative year and then at 2 years. If these smears were normal, the patient could then revert to the normal screening programme.

A retrospective longitudinal review identified 341 womcn who had had a hysterectomy in association with CIN 3 , in Taysidc Region, during the ycars 1967-1977; 219 (64%) had completed 10 years of cytology follow-up and of 140 women eligible for 15-year smears 79 (56%) complcted the 15-year follow-up. Eight (4%) of the 219 patients developed abnormal cytology, but in six, smears reverted to normal spontaneously. Two patients had persistently abnormal smears and vaginal intraepithelial ncoplasia (VAIN) was diagnosed. Only one patient completing 15-year follow-up had an abnormal smear and VAIN later diagnosed. No patient over this 15-year period developed invasive vaginal carcinoma. Sixty vaginal carcinomas were identified during the period 1957-1987 from the gynaecology cancer register; only one was associated with a previous diagnosis of CTN 3 at hystcrectomy. With such data we would propose screening 6-monthly during the first postoperative year and then at 2 years. If these smears were normal, the patient could then revert to the normal screening programme. 'l'he aim of a successful cervical cytology scrccning programme is to detect and treat prc-invasive cervical intraepithelial neoplasia (CIN), thereby reducing the incidence and mortality of cervical cancer (Duguid ef al. 1985).While CIN is a frequently cncountered lesion, the histologically identical tutnour in the vagina, vaginal intraepithelial neoplasia (VAIN), is rare. It has bccn generally assumed that the natural history of the two conditions may be similar with regard to the possible devclopment of invasive cancer. For this reason any patient undergoing hystercctomy in association with CIN 3 (carcinoma in sitdsevere dysplasia) has traditionally been carefully lollowed with frequent vault smears. Such intensive follow-up

The pregnancy rate in patients undergoing assisted conception treatment following pituitary desensitization with GnRH analogue and ovarian stimulation with gonadotrophins has been reported to be higher when ovarian function is supported in the luteal phase by exogenous human chorionic gonadotrophin (HCG). In the present study, we have examined the effects of culturing monolayers of granulosa cells, collected from such patients at oocyte retrieval, for various time intervals in the presence or absence of HCG on their subsequent ability to secrete progesterone (P4) either spontaneously or in response to further challenge with HCG. When cultured in the absence of HCG, granulosa cells demonstrated a rapid decline in both the spontaneous P4 secretion rate and the ability to secrete P4 in response to HCG. Maintenance in the presence of HCG inhibited the rapid decline in ability to secrete P4 spontaneously and also significantly enhanced the ability to respond to subsequent HCG stimulation. These results suggest that HCG support in the luteal phase in GnRH analogue-treated patients may have a cellular basis for its action both in maintenance of P4 secretion and also in rendering the corpus luteum more sensitive to rescue by conceptus-derived HCG.

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All cone biopsies in the Dundee and Angus Region between 1974 and 1987 were identified. One hundred and seventeen (25.5 per cent) were carried out as day cases and 342 (74.5 per cent) as inpatients. No differences were found in postoperative complication rates between the two groups or with the operative technique employed. Where medical criteria are satisfactory, day case cone biopsy is a safe and cost effective procedure. @ Institute of Obstetrics and Gynaecology Trust, 1990 J Obstet Gynaecol Downloaded from informahealthcare.com by University of Sydney on 01/05/15 For personal use only. 436 Journal of Obstetrics and Gynaecology (1 990) Vol. 1 O/No 5 0 z 74 75 76